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FOR OFFICE USE: !' t APPLICATIONS FOR-SANITATION PERMIT ------- ------------------------------------------------ t' 'Complete in Triplicate) Permit No. -3---------------- ------------------------------------------ � This hermit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local iYealth District for a permit to construct and install the work herein described. This apc tion 1e i co li Rh my Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO ATIOIV .---'--- ' S!" -- - Ul�_5�---Fie NKSIU S TRACT -3 Owner's Name ~------- --- ----------------Phone f� - --------------------------------- Address O .� �' _ City _ �`----- � ------------------------------------- _ _ � _- Contractor's Name --, /lJ1 /--->-------------------•-- -----.License #o `.�l r .__ Phone Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ;❑ Number of living units:_._Z-_----- Number Motel bedrooms Garbage ' ❑ Other ,ev 6 � Water Supply. Public System and I �-""" Grinder j�-Q-_ Lot Size _�bl'`_ 0_�""��_ � PPY- Y name ------------------------------------------ ----------------------- ❑ Character of soil to a depth of 3 feet: Sand [-] Silt❑ Clay ❑ Peat[I Sandy Loam E] Clay Loam ❑ 11 Q Hardpan ❑ -,AdobeFill Material ______------ If yes, type ------ ---------------------- r ________._- """"___ f , ------ a E (Plot, plan, showing size oblot, locat oh'of system,in relation to wells, buildings;etc. must be placed on-reverse side.) NEW INSTALLATION: (No e septic tank or see a h P p g�-,pit permitted if public sewer is cyvails�ble`w�hin 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK, Size_ p � ( Liquid Depth - Capaci - � ��Q --- TYPe�- - --- Material- �_- No.�Compartments _- ---_-.. Distance to nearest: Well ------------------------------------Foundation __/� ______- Prop. Line ____ _, __• !••-_ LEACHING LINE No. of Lines -----oZ-------------- Length of each line-« -------------- Total Length .: Qf--- 'f_ ' Type Filter > te'iaf� _-Depth Filter Material� --:------•------------------- Distance -----_�_---�+ 'D' Box Distance to nearest. Well _________ ______________ Foundation r ' �{'�- ------------- Property Line ---,�------ - :�.. SEEPAGE PIT Ar Depth �- -- Diameter -fes-______ Number ----- ____----------------- Rock Filled Yes N.o 'i❑ Water Table Depth -------�,�----------------------- /f h Rock Size Distance to Nearest: Well ------- -""---------------Foundation -_7OJ___--.____ Prop. Line _.,/ -----___:c_-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------- """""} Septic Tank (Specify Requirerments ) __-- e ------------------- ----------••-------------- -------------------------Dis osal Field'(S cifY Re urr ` t r t ------------------------------------------------------Y------------------------------------------------- -_--- - ii (Draw existing and required addition on reverse side) I I .I hereby certify that I have prepared this application and that the wo;A will be done in'accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation',laws of California.", Signed - - -------------------------i----------- Owher s BY -------- Tit t 3 ther than owner), �1`�----•---------------- 1e4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- t ------ DATE - - - - --------------------------------------�------- -----------------DATE -- - ----- + 3UfLDING PERMIT ISSUED - ADDITIONAL COMMENTS ``----- ---- - ------------------------------------------- --------------------------------- --------- - -------------------------- - ----------------------------------------------------------------------------------- -- ---------------------------------------------- --------------------------------------------------------------------------------------`------------ '---- -------------------------- ----------- - -- --- - --------------------------------------------- \r/ --- ------------- - - Final Inspection b t Date /1�7- , --------- ---------------------- -- P Y ------------- - -- --------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' E. Ff. 9 1-'68 Rev. SM